Secondary Abdominal Ectopic Pregnancy after a Failed Attempt at Medical Termination: A Rare Case Report

Abstract

Background and Aim: Ectopic pregnancy is the leading cause of maternal morbidity and mortality during the first trimester and the incidence increases dramatically with assisted-reproductive technology (ART). It occurs when a fertilized ovum is embedded outside of the endometrial cavity's lining. Aim of this study to demonstrate the diagnostic challenges encountered along with the surgical complications that can arise in patients diagnosed with an abdominal ectopic pregnancy. Presentation of the case: A 26-year-old, para two, Afro-Guyanese woman was referred to the high-risk clinic at the Georgetown Public Hospital Corporation (GPHC) with an ultrasound finding of multiple foetal malformations, the patient had a failed medical termination of pregnancy and was taken for exploratory laparotomy, where she was diagnosed with an abdominal ectopic pregnancy with placental tissue adhered to the small and large bowel as well as the omentum along with a small defect noted in the right Fallopian tube. Discussion: The abdominal location for an ectopic pregnancy is one of the rarest forms at 0.9–1.4% of all ectopic pregnancies and can present a challenge with diagnosis. Abdominal ectopic pregnancies carry a higher risk of mortality because of hemorrhaging and injury to surrounding organs. Diagnosis of an abdominal ectopic pregnancy can be difficult, with some cases requiring more advanced imaging techniques. Conclusion: We report on a case of a patient who was undergoing medical termination of pregnancy for an intrauterine foetal demise along with foetal malformations. There was subsequently suspicion of a uterine rupture, and she was taken for an emergency exploratory laparotomy, which revealed a ruptured abdominal ectopic pregnancy. We aim to highlight the diagnostic challenges posed by these cases, which can lead to increased morbidity and mortality.